Sleeve Gastrectomy - Metabolic Changes

Many will assert that VSG has no metabolic changes which I found curious, and when I get curious I...annoy my bariatric surgeon, haha. Kidding aside, I throw myself into research because, well, I want to understand why. I've found some interesting things.

This study in particular is interesting. Due to copyright I am not reposting the full text of the study which I have, but the abstract gives a decent overview. An intestinal bypass affects many of these for far longer. However, just getting a gastrectomy also appears to alter them.

GLP-1 btw is what the weightloss drug Saxenda/Victoza (liraglutide) is, actually.

I have many more studies than I thought I'd find and I will likely cobble them into an article eventually. However, it looks to be the case that there is a powerful metabolic component with the sleeve gastrectomy that is not restriction based.

Very cool you posted this- off to go read.

Thanks for this, Donna! I was diagnosed Type 2 diabetic for 2.5 years prior to surgery. My blood sugar was 264 the day I was diagnosed. I was taking Metformin the last 6 months prior to surgery because diet alone wouldn't get my numbers under 147. I was instructed to stop the Metoformin when I started my 2-week pre-op clear liquid diet. I haven't taken it since. At my one-year checkup by blood glucose measured 78. I haven't had it read over 110 after eating since surgery and it has been under 100 for the last 5 months. I couldn't be happier!

My blood sugar the morning of surgery (24 hours fasted) was 180, and prior to that on a low carb diet it went between 130-150 even with very low carbs. 4-6 hours after surgery it was 70, and to this day my fasting blood glucose hovers between 70-80. If anything it should have gone up from being on IV infusions of glucose, as I was receiving more glucose than I had eaten for years whilst in the hospital. Nope, though, it stayed low.

Don't get me wrong - I definitely ate my way to a crap metabolism and high blood sugar. However, it's astonishing to me how quickly surgery flipped it on its head when even a strict diet had not.

Two months ago though my A1C was 4.3% when it had been almost 3 times that in 2009 when I weighed 750 (and probably more) - largely due to the sleeve's effect combined with a ketogenic diet. That's pretty much unheard of.

That's how powerful any of the permanent WLS procedures are, though. It's sort of astounding.

My A1c didn't drop that much with surgery which surprised me... ketogenic and all... I went from 5.9 to 5.4

Huh, I wonder why! Though, that's still a fabulous A1C drop you had, actually. I don't know as much about A1C as digestive hormones. I am curious now, so I'll see what I can turn up.

My experience is the same as Cathy's. My sugars were never below 140 (even first thing in the morning fasting). After the surgery, my numbers have not gone over 115 and my morning numbers are between 90 and 96. The fasting numbers are proof that the change is not restriction based. I could fast for two days before surgery and my numbers would still not drop below 130. I can't wait to see what my A1C is now.

Amen, LadyBlu...same here!!

Thanks Donna.

I always get a little peeved when folks say the sleeve is restriction-only, a sort of updated version of the band. It does much more than that. Sure, the metabolic changes are not as pronounced as RNY, and RNY is not as pronounced as a DS.

My surgeon has often said that the restriction portion of any WLS is not nearly as consequential as the metabolic and other changes.

I'd go so far as to argue that sleeve size is irrelevant, largely for that reason. First of all, there's minimal difference between, say, 36F, 40F (my sleeve size) and 50F (many DS patients' size) in terms of capacity. Like, a few millimeters won't stop you from eating like crap if you are going to, well, eat like crap.

People focus on consumption as creating an energy surplus. The truth is that obesity is hormone-driven rather than calorie-driven, and that it's behavior which fuels what hormones are dominant. The best way to avoid weight gain is to minimize carbohydrate we eat, regardless of obesity or not. That's also why many who were super morbidly obese, or formerly morbidly obese, will regain with higher carbohydrate consumption, even minimally. All calories are not equal units of energy, and while when broken down there is matter and energy equivalency, what happens to the energy is determined to a large degree by what hormones are dominant in your body.

Don't get me wrong, as a severe caloric deficit will, of course, cause weight and muscle loss. However a significant portion of weight gain is controlled by hormones, particularly neuroendocrine ones that affect both the gut and the brain. Insulin is a huge example of this, as insulin in significant amounts is required to store fat.

For reasons we don't understand, an intestinal bypass of any sort results in more profound and long-lasting benefits. Some people have attempted to stitch a lining into the intestines to get a similar result...and surprisingly they do, which is really interesting.